Endocrine Abstracts

Introduction

In this study we present data on the long-term outcomes of treatment of patients with moderate and severe GO.

Methods

98 patients with GO attending our clinic for the last 13 years and received treatment for moderate to severe GO were evaluated for their long-term response to treatment. Initial decision for treatment was based on activity and severity of the disease, assessed by CAS-score and NOSPECS respectively and the presence of ocular muscle edema (OME) at the MRI–STIR imaging. Patients with moderate to severe disease received iv corticosteroids according to the EUGOGO protocol (totally 4.5 g methylprednisolone for 12 weeks), and those with persisting disease continued with per os prednisolone (30 mg daily, tapered over 3 months). Response to treatment was evaluated based on changes of both CAS-score and OME at the MRI–STIR. Thyroid and liver function, and smoking status were also assessed.

Results

The patients’ mean age was 52.08 ± 13.11 years. 30/98 patients (30.61%) had mild GO (mean CAS-score 2.58 ± 0.47, no or mild OME at the MRI-STIR) and received no treatment. 68/98 patients (69.38%) had moderate to severe GO (mean CAS-score 4.13 ± 1.26, intense OME at the MRI–STIR) and received iv treatment. 20/68 patients (29.41%) had a significant improvement (mean CAS-score 3.04 ± 0.07, mild to moderate disease, and no or mild OME at the MRI–STIR) and received no further treatment. The rest 48/68 patients (70.58%), due to persisting disease (mean CAS-score 3.30 ± 1.21, and intense OME at the MRI–STIR), continued with the per os protocol and were improved at the end of treatment (mean CAS-score 2.27 ± 1.14, no or mild OME at the MRI–STIR). Only 3/68 patients (4.41%) who received iv corticosteroids developed mild transaminasemia. All patients were euthyroid at the initiation of treatment and 6/68 continued smoking. Recurrence observed in 11/68 patients (16.17%) who had prior treatment, with mean CAS-score 3.64 ± 1.28 and intense OME at the MRI–STIR, at a mean 21.5 ± 32.3 months (range 1–108 months). They received additional iv treatment (1.5 g methylprednisolone for 6 weeks) and all improved significantly (mean CAS-score 2.97 ± 0.95, no or mild OME at the MRI–STIR).

Conclusion

Treatment with iv corticosteroids followed by oral corticosteroids in those with persistent disease based on CAS and MRI–STR findings is effective for patients with moderate to severe GO, minimizing the recurrence rate and has no serious side effects. MRI–STIR imaging of the ocular muscle is a useful tool for treatment initiation and evaluation of response.